WALESBYFOREST

VOLUNTEER APPLICATION FORM

SURNAME & TITLE (Mr /Mrs /Miss /Other) / Forenames:
Name known by: / Date of Birth:
Address:
Post Code: / Telephone (day):
Telephone (evening):
Mobile telephone:
Facsimile:
E-mail: ______

Are you a member of the Scout or Guide Association?Yes/No

If yes, please give details of appointment and Group / Company ______

Do you hold a current clean driving licence?Yes/No

Have you ever been refused a driving licence because of ill health?Yes/No

Have you previously been a volunteer or summer staff at Walesby?Yes/No

Are you an active member of a Scout / Guide association?Yes/No

If yes please give details______

Please indicate the approx periods of time you can give to Walesby.

______

Using the guide below, please grade yourself on your skill and experience in the following activities:-

1 = Some experience;2 =Experienced but require additional training;3 = Experienced;

4 = Fully competent to instruct;5 = Qualified

Skill/Experience / 1 / 2 / 3 / 4 / 5 / Qualifications / Renewal Date
First Aid
Climbing
Archery
Rifle Shooting
Canoeing
Kayaking
Life Guard
Sailing

Please add any other skills you feel would be useful.

Brief details of experience, skills, civic duties, voluntary work etc:Please use further sheets or attach C.V.

______

Have you ever been convicted of a criminal offenceYES / NO

(Declaration subject to the Rehabilitation of Offenders Act)

______

Please give details of next of kin or a person who can be contacted in an emergency

Name:______Relationship: ______

Address:______

______Postcode:______

Telephone:______Mobile:______

Please provide two referees who have known you for at least 3 years.

Name: ______Name: ______

Position:______Position:______

Address:______Address:______

______

______

Telephone: ______Telephone: ______

Email: ______Email: ______

DECLARATION

Signed ______Date ______

For Office Use

Starting Date

Interviewed by ______Date ______